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WorksheetsExam 4 (Medsurg): Cancer
Total questions: 115
Worksheet time: 1hrs 1mins
Cancer occurs in people of all ages, but the majority of cases are diagnosed in those over what age?
25
40
55
70
Both the incidence and mortality rate of cancer has been declining.
True
False
Which cancers have decreased in global incidence?
A) Lung, colorectal, breast, and oral cancer
B) Esophageal, skin and bone cancer
C) Pancreatic, kidney, and liver cancer
D) All cancers
Fill in the blank: Cancer is the ______ most common cause of death in the US.
second
third
fourth
fifth
Fill in the blank: Cancer is the leading cause of death in people aged ______ years old.
40-79
20-39
80-99
10-19
What are the two major dysfunctions in the process of cancer development?
Defective cell proliferation and defective cell differentiation
Defective cell death and defective cell growth
Defective cell migration and defective cell adhesion
Defective cell signaling and defective cell metabolism
Defective cell proliferation refers to:
Growth
Specialization/cell type
Cell death
Cell migration
Stem cells are:
Differentiated cells
Undifferentiated cells
Dead cells
Cancer cells
Cancer cells grown in culture are characterized by loss of contact inhibition.
True
False
Cancer cells have no regard for cell boundaries.
True
False
Protooncogenes regulate normal cellular processes, such as promoting ______.
growth
apoptosis
mutation
senescence
Fill in the blank: Mutations that alter cellular expression can activate tumor suppressor genes to function as _________
ONCOGENES
ENZYMES
HORMONES
ANTIBODIES
PROTOONCOGENES
About what percentage of all cancers or predisposition to cancers are inherited?
1-2%
5-10%
20-30%
50-60%
Most cancers are acquired from ______ damage.
genetic
ribosomal
hormonal
reticulocyte
Many carcinogens are detoxified by protective enzymes and are harmlessly excreted.
True
False
Which of the following is NOT a chemical carcinogen?
Benzene
Arsenic
Formaldehyde
Celecoxib
Which of the following are toxic metals that act as carcinogens?
A) Chromium, lead, cadmium
B) Iron, copper, zinc
C) Silver, gold, platinum
D) Sodium, potassium, calcium
SATA: Select all of the carcinogenic gasses.
carbon monoxide
hydrogen cyanide
ammonia
butane
carbon dioxide
Radiation can cause cancer in ______ of human tissues.
one or two types
all
almost all
about half of
Fill in the blank: UV radiation is associated with melanoma and squamous and basal cell _________?
carcinoma
sarcoma
adenoma
lymphoma
Which virus is associated with Burkitt's lymphoma?
HIV
Epstein-Barr virus
Hepatitis B
HPV
Kaposi sarcoma is associated with which viral infection?
Hepatitis B
HIV
HPV
Epstein-Barr virus
Hepatocellular carcinoma is linked to which virus?
HPV
HIV
Hepatitis B
Epstein-Barr virus
Squamous cell carcinomas are associated with which virus?
HPV
HIV
Hepatitis B
Epstein-Barr virus
Cancer promotion is characterized by ______ proliferation of altered cells.
reversible
irreversible
rapid
slow
Which of the following is NOT listed as a factor in cancer promotion?
Obesity
Smoking
Alcohol
Exercise
Dietary fat
The latent period of cancer may range from ______ years.
1-40
1-10
10-20
20-30
For cancer to be clinically evident, a tumor must reach a ______ that can be detected.
critical mass
benign state
latent phase
remission point
Progression of cancer is characterized by all of the following EXCEPT:
Increased growth rate of tumor
Invasiveness
Presence of metastasis
Decreased cell division
Metastasis begins with ______ growth of the primary tumor.
rapid
slow
irregular
delayed
Tumor angiogenesis refers to the process by which the tumor develops its own ______ supply.
blood
nerve
bone
lymph
What are the main sites of metastasis for cancer?
Brain and cerebrospinal fluid
Lung, Liver
Adrenal glands, Bones
All of the above
What is the FIRST node confronted as tumor cells spread through the lymphatic system called?
Sentinel lymph node
Axillary lymph node
Thoracic lymph node
Lymphatic trunk
Biopsy of the sentinel lymph node can help determine the extent of cancer.
True
False
______ metastasis occurs when tumor cells travel to distant nodes.
Skip
Jump
Slide
Transverse
Some cancer cells have changes on their surface antigens called ________.
Tumor-associated antigens (TAAs)
Major histocompatibility complex (MHC)
Immunoglobulins (Ig)
Cytokine receptors
SATA: Which cells are involved in immunologic surveillance?
Cytotoxic T cells
Natural killer cells
Macrophages
B cells
Erythrocytes
T cells kill tumor cells DIRECTLY and produce ________.
cytokines
antibodies
hormones
enzymes
Natural killer cells and macrophages can ______ tumor cells.
LYSE
INHIBIT
PRODUCE
TRANSFORM
B cells produce ________ that bind to tumor cells.
antibodies
hormones
enzymes
antigens
SATA: Which of the following are possible mechanisms by which cancer cells evade the immune system?
Suppression of factors that stimulate T cells
Weak surface antigens
Products secreted by cancer cells suppress immune response
Induction of suppressor T cells
Blocking antibodies binding to TAAs, preventing recognition
CA 15-3, CA 27-19, HER-2 are markers for which type of cancer?
Breast cancer
Lung cancer
Prostate cancer
Colon cancer
Which system do lymphomas and leukemias originate from?
Hematopoietic system
Cardiopulmonary system
Lymphatic system
Protooncogene system
Carcinomas originate from which embryonal layers?
Ectoderm and endoderm
Mesoderm and ectoderm
Endoderm and mesoderm
Ectoderm only
Sarcomas originate from which embryonal layer?
Mesoderm (connective tissue, bone, muscle, fat)
Ectoderm (skin, nervous tissue)
Endoderm (gastrointestinal tract, lungs)
Neural crest (peripheral nervous system)
A tumor that is malignant:
is not a threat to the patient's health
can metastasize and spread throughout the body
will remain localized and cause permanent damage
causes proliferation of highly differentiated cells systemically
SATA: Select the 3 main ways that cancerous tumors can be classified.
Anatomic site
Histology
Staging
Serology
Function
What is the PRIMARY classification of neoplasms?
Anatomic site
Histology
Extent of disease
Staging
Which type of neoplasm classification examines how closely the tumor cells resemble the tissue of origin?
Histology
Staging
Serology
Oncofetal Antigens
SATA: What is evaluated to determine how closely cancer cells resemble their tissue of origin?
Appearance of cells
Number of mitotic figures present
Presence of inflammatory cells
Amount of connective tissue
Degree of differentiation
Poorly differentiated tumors have a ______ prognosis than those closer in appearance to normal cells.
poorer
better
similar
uncertain
Which grade of cancer cells are well differentiated and differ slightly from normal cells?
Grade 1
Grade 2
Grade 3
Grade 4
Grade 2 cancer cells are:
Slightly different from normal cells, well differentiated
Abnormal and moderately differentiated
Very abnormal and poorly differentiated
Immature, primitive, and undifferentiated
Grade 3 abnormal cells are very abnormal and ______ differentiated.
poorly
well
moderately
fully
Grade 4 cancer cells:
cells differ slightly from normal cells, are well differentiated
are abnormal and moderately differentiated
are very abnormal and poorly differentiated
are immature, primitive, and undifferentiated, with cell of origin difficult to even determine
A tumor with a clinical staging of 0 would be defined as:
cancer in situ
tumor limited to tissue of origin
limited local spread
extensive local and regional spread
Clinical staging is done at completion of diagnostic workup to guide effective treatment selection.
True
False
Stage classification is changed once established.
True
False
SATA: What should the RN do to help patients that are experiencing fear and anxiety due to their cancer diagnosis?
actively listen to patient concerns
manage your own discomfort
give clear explanations and repeat if necessary
refer to the oncology team when possible
give written information for reinforcement
Managing caregiver burnout is a MAJOR part of the nurse's role in oncology care.
True
False
Fill in the blank: Indicated diagnostic studies depend on the ______ of cancer.
SITE
HISTOLOGY
SIZE
STAGE
Which diagnostic study is used for proliferation and differentiation in oncology?
Cytology studies
Chest x-ray
CBC+chemistry profile
Radioisotope/PET scans
SATA: Select all of the techniques that can be used to determine the location of neoplasm(s) in oncology patients.
MRIs
Endoscopies
Cytology Studies
Radiographic Studies
Chemistry Profiles
What are tumor markers?
Radioactive tracers on tumor cells
Radioactive tracers on specific genetic sequences
Pathologic evaluation of tissue sample
Surgery alone
What does a biopsy involve?
Histologic examination by a pathologist of a piece of tissue
Surgical resection of all localized malignant tissue
Radioisotope tracer markers inserted into neoplasms
Targeted biologics therapy
What is the ONLY DEFINITIVE MEANS to diagnose cancer?
Biopsy
PET scan
Radiographic study
Cytology Study
All of the above
SATA: Select the different types of biopsies.
Needle biopsy
Aspiration biopsy
Incisional biopsy
Excisional biopsy
Radioisotope biopsy
Which of the following is a cancer treatment option focused PRIMARILY on relief or control of symptoms?
Curative therapy
Palliative therapy
Intense radiation therapy
Aggressive chemotherapy
Palliative care and treatment are NOT mutually exclusive and can both take place concurrently.
True
False
Biopsy can help determine whether a tumor has the specific target for personalized treatment.
True
False
All types of cancer have personalized treatment options.
True
False
SATA: What are some barriers patients may face when attempting to personalize their cancer treatment?
Financial strain
Time consuming
Lack of insurance coverage
Lack of willingness to get better
What is the oldest form of cancer treatment?
Surgery
Chemotherapy
Radiation therapy
Immunotherapy
What is the trend in cancer surgery?
Trend is toward less radical surgeries
Trend is toward more radical surgeries
Trend is toward no surgeries at all
Trend is toward only chemotherapy
Prophylactic removal of nontrivial organs has been successful in reducing the incidence of some cancers.
True
False
What is removed in curative surgery for cancer?
Only the resectable tumor
Only the entire tumor
Only the entire tumor and surrounding tissues
Entire organ regardless of tumor size
A _______ procedure may be used if the tumor cannot be completely removed with resection alone.
demyelinating
debulking
incendiary
dissolving
In neoadjuvant cancer therapy, chemotherapy and radiation therapy are performed _______ surgical procedures.
before
after
during
instead of
Why is the immune system often inadequate at rejecting and destroying cancer cells?
Cancer cells are unable to be targeted by lymphocytes, rendering T and B cells ineffective
Cancer cells corrupt the lymphatic system, and halts the process of phagocytosis
Cancer cells arise from normal human cells that leukocytes would normally not attack
What is the importance of examining oncofetal antigens when treating cancer patients?
Indicates likelihood of radiation toleration
Indicates likelihood of chemotherapy toleration
Helps to monitor effectiveness of therapy and look for recurrence
Helps to determine life expectancy of particular cancers
A tumor with a clinical staging of 1 would be defined as:
cancer in situ
tumor limited to tissue of origin; localized tumor growth
metastatic
extensive local and regional spread
A tumor with a clinical staging of 2 would be defined as:
tumor limited to tissue of origin; localized tumor growth
extensive local and regional spread
cancer in situ
limited local spread
A tumor with a clinical staging of 3 would be defined as:
cancer in situ
limited local spread
extensive local and regional spread
metastatic
A tumor with a clinical staging of 4 would be defined as:
metastatic
cancer in situ
tumor limited to tissue of origin; localized tumor growth
extensive local and regional spread
SATA: Select some palliative cancer treatments.
Insertion of gastric feeding tube
Placement of central venous access device
Prophylactic surgical fixation of bones at risk for pathologic fracture
Use of chemicals given as a systemic therapy for cancer
Different types ionizing radiation used to break the chemical bonds in DNA
Another name for chemotherapy is:
antineoplastic therapy
radiation therapy
targeted immunotherapy
prophylactic ionization therapy
SATA: Which of the following are regional delivery methods for chemotherapy?
Intraarterial: delivers drug through arteries that supply the tumor
Intraperitoneal: delivers drug to peritoneal cavity for treatment of peritoneal metastases
Intrathecal or Intraventricular: involves lumbar puncture and injection of chemotherapy into subarachnoid space
Intravesical: delivers drug to the bladder
Intracranial: delivers drug directly to the CNS
Chemotherapy is considered ________ for most solid tumors and hematologic cancers.
the mainstay treatment option
not ideal treatment
the last resort treatment option
contraindicated and dangerous
The preparation and handling of chemotherapy agents may pose an occupational hazard to the nurse administering them.
True
False
Any nurse with a valid RN license can handle chemotherapy medications.
True
False
CHEMOTHERAPY AGENTS CANNOT DISTINGUISH BETWEEN NORMAL CELLS AND CANCER CELLS.
True
False
The side effects of chemotherapy are due to:
ionizing radiation
caustic extravasation
normal cell destruction
tumor lysis
Radiation is one of the oldest nonsurgical methods of cancer treatment. How does it work?
ionizing radiation breaks the chemical bonds in tumor cell DNA, causing cell death
ionizing radiation replaces hematopoietic stem cells
ionizing radiation burns and destabilizes tissue surrounding the neoplasm
ionizing radiation fuses electrons of tumor cell ribosomes, resulting in ineffective replication and RNA transcription
Targeted immunotherapy for cancer is also called:
antineoplastic therapy
radiation therapy
biofeedback therapy
biologic therapy
Targeted immunotherapy ________ the immune system and creates an environment not conducive for the growth and proliferation of cancer cells.
eliminates
suppresses
subverts
boosts
Targeted immunotherapy allows the immune system to do what in regards to cancer?
revert oncogenes back to protooncogenes
break the chemical bonds in tumor cell DNA
replace lost tissue from neoplasm metastasis
attack cancer cells directly
Sometimes, patients may not report adverse effects of chemotherapy, radiation therapy, and targeted immunotherapy for fear of cessation of treatment.
True
False
SATA: Select the types of hematopoietic stem cell transplants used to treat cancer.
bone marrow transplant
peripheral stem cell transplant
central nervous stem cell transplant
reticulocyte transplant
liver enzyme stem cell transplant
Why are liver function tests monitored in ALL cancer patients?
LFTs can determine cancer progression
LFTs can determine likelihood of future remission
LFTs can indicate which type of chemotherapy medications will be most effective
LFTs indicate how much chemotherapy and radiation a patient can tolerate
Hematopoietic stem cell transplants allow patients to receive _______ doses of chemotherapy and/or radiation therapy.
lower
higher
slower
faster
When would the HCP recommend a cancer patient undergo a hematopoietic stem cell transplant?
after initial diagnosis of cancer
in conjunction with the first chemotherapy treatment
when standard chemotherapy or radiation doses fail to produce a therapeutic response
when standard chemotherapy or radiation doses produce a response that is far too intense
Hematopoietic stem cell transplants are highly toxic procedures with many risks, including death.
True
False
SATA: What are some posttransplant complications that could arise from hematopoietic stem cell transplants?
bacterial infections
viral infections
fungal infections
parasitic infections
graft vs host disease
In Graft vs Host Disease, T cells from the ______ marrow recognize the _______ as foreign and attack it.
graft/donor, recipient/host
recipient/host, graft/donor
One complication of cancer is dysgeusia. What does dysgeusia mean?
Altered sense of smell
Altered sense of taste
Altered sense of touch
Altered genetic mutations
What is the MOST common side effect of chemotherapy?
bone marrow suppression
fatigue
integumentary reactions
myelosuppression
The onset of myelosuppression from chemotherapy medications is related to the life span of ______ cells.
tumor
protooncogene
blood
cardiac
hepatic
A cancer patient's lowest blood cell counts often occur ______ days after starting chemotherapy.
1-2
5-8
7-10
12-15
The RN should consider prophylactic administration of _______ to reduce GI effects of cancer treatment
antihistamines
prostaglandins
antiemetics
anticholinergics
Skin reactions to cancer treatment usually develop _______ hours after treatment.
1-24
10-36
14-72
72-144
The pulmonary side effects of cancer treatment may be progressive and irreversible.
True
False
"Chemo brain", a state of mental cloudiness associated with chemotherapy, can last for _____ in severe cases.
days
weeks
months
years
Chemotherapy has no effect on the reproductive system.
True
False
SATA: When assessing a patient undergoing chemotherapy, what are some complications the RN should be on the lookout for in terms of expected adverse effects?
alkalosis
dehydration
low urine output
acidosis
excessive urine output
SATA: What are some characteristics of the ideal diet for chemotherapy patients?
low fiber
high calorie
high protein
high fiber
low calorie
